Monday, August 7, 2017

What is Medicare Advantage Plan (Part C)

What is Medicare Part C? It's an alternative to the traditional plans. More commonly referred to as Medicare Advantage, private insurance companies who receive compensation for each individual they insure carry these alternative options. Those who have chosen a Medicare Advantage Plan are still enrolled in traditional Medicare and must continue paying their Medicare Part B premiums for 2017.

Medicare Advantage Plan (Part C)

When Medicare Parts A, B, and C are combined into a comprehensive plan, you have Medicare Part C. Medicare Advantage plans also come with the addition of several benefits not offered with traditional Medicare plans. While all plans are required to have equivalent coverage to Medicare plans, there is a significant amount of variation between Part C plans such as pricing and benefits.

If you're considering this plan, each option should be researched thoroughly. There are many different types of private plans that are available, ranging from HMO set ups to Medical savings accounts. These plans are responsible for the coverage of all of your Medicare Part A & Medicare Part B needs and are held to the same standards that govern the traditional plans, except being required to cover costs related to hospice stays.

Not all plans are the same, but many offer benefits such as prescription drug coverage, vision, dental, hearing, and even long-term care coverage. Because Part C plans are not required to cover an expense deemed medically necessary, it's always important to check with your plan before assuming the coverage of a benefit. Due to being a part of a privately owned insurance companies, Medicare Part C plans are often a part of a network.

How Much is Medicare Advantage Part C

Part C plans have the potential to save their members a considerable amount of money, depending on their coverage needs. Savings are largely possible because as opposed to a traditional plan, you can expect to pay a flat copay for their medications and doctor visits, as opposed to a percentage of the total cost.

Is there a Donut Hole

Additionally, a Part C plan doesn't have a donut hole. Should deductibles be met, beneficiaries don't owe on their medically related costs for the remainder of the coverage period. Deductibles in a Part C plan, however, are often much higher than those associated with a traditional plan.

Will an Advantage Plan Save Me Money

Whether or not an Advantage Plan would save you money is dependent on several factors, like particular drugs used and whether or not medications are on the plans approved list. It's also beneficial to determine whether or not you find yourself needing extra services like dental, vision and hearing often enough to benefit from the additional coverage.

An insurance professional would be able to help you determine what your costs would be with a Part C plan as opposed to a traditional Medicare plan, allowing you to make a financially sound coverage decision.

Medicare Advantage Part C Requirements & Exceptions

Admittance into a Part C plan comes with a few requirements and exceptions.


  1. You must live in the coverage area of a particular plan
  2. Must already have Original Medicare

With few exceptions, they can't qualify if they have end-stage renal disease, which is kidney failure that requires dialysis and a kidney transplant.

It's important to ensure that you choose the plan that best fits your needs, as besides in extreme cases the enrollment periods are limited to a few weeks, once a year. Enrollment periods are between October 15th and December 7th of each year. During this period you can either sign up for a Part C plan or switch between plans.

Should you choose to leave your Part C plan and return to a traditional Medicare plan, this time frame falls between January 1st and February 14th.